Just presenting another perspective. Something I have learned in my practice of pediatrics. I try not to recommend a specialist to a patient if I am doing a consult. It is a courtesy to first speak with the primary physician rather than directly referring. This might be part of the anger on the part of the pediatrician. Perhaps he/she also had other boundary issues. However I would also be miffed if my patients were referred to another physician without my being first informed/consulted. Also in these days of managed care in the US, most of the time one MUST go through the primary care physician for a specialist referral to be approved. Hope this helps, Pierrette Mimi Poinsett MD FAAP Modesto CA